Tag: geriatrics

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April 23, 2026April 20, 2026

Real Life Examples: Polypharmacy and the Prescribing Cascade Part 1 of 2

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Polypharmacy isn’t just about medication count—it’s about cumulative risk and unintended consequences. One of the biggest drivers is the prescribing cascade, where a drug side effect is mistaken for a new condition, and another medication gets added instead of addressing the root cause.

You see this all the time in practice. A patient starts amlodipine and develops edema, then gets placed on furosemide. Or donepezil leads to urinary symptoms, and oxybutynin is added—potentially worsening cognition. These patterns add risk quickly.

In this episode, I’ll break down common examples that I have recently encountered in practice.

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Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated)

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October 30, 2025October 30, 2025

10 Common Examples of The Prescribing Cascade

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One of the most important yet often overlooked concepts in pharmacology is the prescribing cascade. It occurs when a new medication is prescribed to treat a side effect caused by another drug, without realizing that the first medication is the root cause. This leads to a chain reaction of additional prescriptions, unnecessary complexity, and often, new adverse effects.

Prescribing cascades can sneak up on even the most careful clinicians. A patient develops a new symptom after starting a medication—perhaps swelling, dizziness, or urinary changes—and instead of identifying the drug as the culprit, another medication is added to manage the symptom. Over time, this cycle contributes to polypharmacy, drug interactions, and reduced quality of life.

These cascades are particularly concerning in older adults, where multiple comorbidities and high medication counts make it easy for adverse effects to be misinterpreted as new conditions. But they can occur at any age and in any clinical setting.

The key to preventing prescribing cascades is maintaining a critical mindset:

Assume any new symptoms could be an adverse effect.
Review the timing of medication changes relative to the onset of symptoms.
Consider deprescribing or adjusting doses before adding new drugs.
Encourage thorough medication reconciliation and communication across providers.

Recognizing and interrupting the prescribing cascade is one of the simplest and most impactful ways we can improve medication safety. In this podcast, I share some of my favorite real-world examples that illustrate just how easily these cascades can happen.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated)

Guide to Drug Food Interactions (Amazon Best Seller)

April 25, 2024April 28, 2024

Ten Commandments of Polypharmacy – Part 1

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On this special episode, I provide some real-life examples and layout 5 of my 10 commandments of polypharmacy.

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Here are the first 5 commandments that are addressed in the podcast.

1. Thou shalt not start, ask for, dispense, or administer medication without reviewing a medication list that is accurate, up to date, and complete with over-the-counter medications and supplements

2. Thou shalt consider utilizing non-drug approaches and interventions to solve patient problems before initiating medication

3. Thou shalt assess if a medication is effective before adding a new medication for the same condition

4. Thou shalt consider any new symptom is an adverse effect of another medication until proved otherwise

5. Thou shalt not start a medication without an appropriate indication and assessing appropriate lab work

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated)

Guide to Drug Food Interactions (Amazon Best Seller)

March 28, 2024March 18, 2024

Beers Criteria Podcast Part 2 or 2

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On this podcast episode, I finish up my breakdown of the Beers Criteria.

I cover the use of sliding-scale insulin and sulfonylureas in geriatric patients. Hypoglycemia is a major concern with both of these diabetes management strategies.

PPIs show up on the Beers criteria list as they can increase the risk of C. diff, pneumonia, fractures, and GI malignancies.

Metoclopramide has dopamine antagonist activity and can increase the risk of EPS and tardive dyskinesia.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated)

Guide to Drug Food Interactions (Amazon Best Seller)

March 21, 2024March 25, 2024

Beers Criteria Podcast Part 1 or 2

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In this podcast episode, I break down some of the most common medications that show up on the Beers criteria list.

I discuss cardiovascular medications in this podcast episode, including rivaroxaban and warfarin, and why they show up on the Beers list.

Alpha-blockers who up on the Beers list as these medications are inappropriate to use for the management of hypertension.

The Beers criteria addresses the use of aspirin in primary prevention. I break down what the criteria state and why it should be avoided in general.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

Support The Podcast and Check Out These Amazing Resources!

Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated)

Guide to Drug Food Interactions (Amazon Best Seller)